Provider Demographics
NPI:1235447699
Name:KELLOGG, AMY L (MS)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3687 UNION VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-9234
Mailing Address - Country:US
Mailing Address - Phone:716-372-0741
Mailing Address - Fax:
Practice Address - Street 1:50 IROQUOIS DR
Practice Address - Street 2:
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779-1361
Practice Address - Country:US
Practice Address - Phone:716-945-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011211235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist